碳酸钙和碳酸镧对维持性血液透析患者FGF23和血管内皮功能的影响

发布时间：2018-05-08 20:41

本文选题：碳酸镧 + 血液透析　；参考：《青岛大学》2015年博士论文

【摘要】：[目的]比较碳酸镧和碳酸钙对维持性血液透析高磷血症患者血磷、成纤维细胞生长因子23(fibroblast growth factor-23,FGF23)和血管内皮功能的影响。[方法]选取50例维持性血液透析高磷血症患者,按1:1比例分为两组,经过2周的药物洗脱期后,分别口服碳酸钙和碳酸镧共8周,同时配以低磷饮食,检测治疗前和治疗后的血常规、血糖、血浆白蛋白、25羟维生素D、血钙、血磷、血甲状旁腺激素(i PTH),同时检测FGF23及测定内皮细胞依赖性舒张功能(flow-mediated dilation,FMD)。[结果]治疗前,FMD与血磷水平呈负相关(γ=-0.55,P=0.002),同时与FGF23水平呈负相关(γ=-0.56,P0.001)。治疗后,碳酸镧组较碳酸钙组血磷下降更显著。碳酸钙组血钙升高,碳酸镧组血钙下降,二者有显著差异。碳酸镧组FGF23较治疗前显著下降,碳酸钙组FGF23没有变化。碳酸镧组FMD显著升高,从6.1%到7.3%(P0.05),碳酸钙组没有变化,仍旧是6.1%。治疗后,FMD的变化与FGF23的变化(γ=-0.42,P0.001)、磷的变化(γ=-0.38,P=0.001)均呈负相关。多重线性回归分析显示,FGF23的变化是FMD变化的独立影响因素(β=-0.28,P0.001),而磷的变化不是FMD变化的影响因素(β=0.05,P=0.6)。[结论]碳酸镧比碳酸钙不仅降磷效果更显著,而且可以明显降低血FGF23水平和改善血管内皮功能,还可以轻度升高25羟维生素D,且不引起血钙的变化。FGF23所引起的内皮功能不良可能是动脉粥样硬化的过程中的一个阶段。该研究也从临床角度探索了血磷和血FGF23水平在慢性肾脏病患者动脉硬化过程中所起到的作用,有助于进一步揭开动脉硬化的机制,做好预防和治疗。
[Abstract]:[objective] to compare the effects of lanthanum carbonate and calcium carbonate on serum phosphorus, fibroblast growth factor (23(fibroblast growth factor-23) and vascular endothelial function in maintenance hemodialysis patients with hyperphosphatemia. [methods] Fifty patients with maintenance hemodialysis hyperphosphatemia were divided into two groups according to 1:1 ratio. After two weeks of drug elution, calcium carbonate and lanthanum carbonate were taken orally for 8 weeks respectively. Blood routine, blood glucose, plasma albumin 25 hydroxyvitamin D, serum calcium, serum phosphorus, serum parathyroid hormone (PTH) were measured before and after treatment. Meanwhile, FGF23 and endothelium-dependent dilatation function were measured. [results] before treatment, there was a negative correlation between FMD and serum phosphorus level (纬 -0.55P0. 002G), and a negative correlation between FMD and FGF23 level (纬 -0.56U P0.001). After treatment, serum phosphorus in lanthanum carbonate group was significantly lower than that in calcium carbonate group. The serum calcium in calcium carbonate group was higher than that in lanthanum carbonate group, and there was a significant difference between the two groups. The FGF23 in lanthanum carbonate group was significantly lower than that before treatment, but FGF23 in calcium carbonate group was not changed. The FMD of lanthanum carbonate group increased significantly from 6.1% to 7.3% P0.05%, but the calcium carbonate group remained unchanged and remained 6.1%. There was a negative correlation between the changes of FGF23 (纬 -0.42 P 0.001, P 0.001) and phosphorus (纬 -0.38% P0. 001) after treatment. Multiple linear regression analysis showed that the change of FGF23 was an independent factor for the change of FMD (尾 -0.28, P 0.001), but the change of phosphorus was not the influence factor of the change of FMD (尾 -0.05, P0. 6). [conclusion] Lanthanum carbonate is more effective than calcium carbonate in reducing phosphorus, reducing FGF23 level and improving vascular endothelial function. There was also a slight increase in 25 hydroxyvitamin D and no change in serum calcium. Endothelial dysfunction caused by FGF23 may be a stage of atherosclerosis. This study also explores the role of blood phosphorus and FGF23 levels in the process of arteriosclerosis in patients with chronic kidney disease from a clinical point of view, which is helpful to further uncover the mechanism of arteriosclerosis and to do a good job in prevention and treatment.
【学位授予单位】：青岛大学
【学位级别】：博士
【学位授予年份】：2015
【分类号】：R692.5

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